Speech DR HANAN BALKHY REGIONAL DIRECTOR WHO EASTERN MEDITERRANEAN REGION Open Briefing – Introduction to WHA79 Can Global Health Make Progress Amid Rupture

17 MAY 2026

Thank you to the Graduate Institute and the UN Foundation for convening this space year after year.

That discipline of accountability matters more than ever right now.

The question today is whether global health can still make progress amid rupture.

My answer is YES.

But only if we are honest about where we stand and bold about what this moment demands of us.

As difficult and contested as the current discussion on global health may be, I strongly believe it will catalyze a much broader shift in how we govern and organize health globally.

We are living through the most significant reconfiguration of the multilateral system since 1945.

And let's be honest: if we were designing the global health architecture today its mandates, financing structures and governance arrangements we would build it very differently.

The current model or rather the model we have evolved into has delivered real results.

WHO and its partners have contributed to major gains in immunization, disease control, maternal and child health, emergency response, and life expectancy.

But over time, every unmet challenge became the rationale for a new initiative, partnership or financing mechanism.

The accumulated effect has been fragmentation, overlap and competition across an increasingly crowded landscape.

WHO is not exempt from this critique. Reform must start with honesty including about ourselves.

The UN80 process reflects a similar realization across the broader UN system, as mandates, efficiencies, and institutional alignment come under increasing scrutiny.

When it comes to global health reform, I believe we need to begin from three places:

• first, the lived realities of countries;
• second, the institutions themselves their mandates, performance and accountability;
• and third, the financing realities increasingly shaping global health priorities.

On lived realities, let me take you for a moment to the Eastern Mediterranean Region my Region where I have visited 21 of the 22 countries and territories, many of them multiple times over the past two years.

It has one of the most diverse health profiles among all WHO regions.

It hosts millions of refugees and displaced people, fragile states with shattered health systems, and middle-income countries facing a growing burden of noncommunicable diseases without the resources to match.

At the same time, it has countries with some of the most advanced health systems in the world.

For regions like mine, these are not abstract governance discussions.

They determine whether fragile states receive sustained support or temporary attention.

Whether displaced populations remain permanently underserved.

Whether countries can produce their own vaccines, diagnostics and therapeutics or remain dependent on the decisions of others.

And whether financing reflects burden of disease or geopolitics.

But country realities only tell part of the story. The players shaping the system have also fundamentally changed.

We are no longer operating in a system defined only by UN agencies.

Today's architecture includes Gavi, CEPI, the Global Fund and major philanthropic actors each with different governance structures, financing models and accountability systems.

You cannot redesign mandates or align financing until you are clear about who the system is actually being designed around.

That is precisely why this joint process matters.

It aims to bring greater clarity to roles, responsibilities and accountability.

Across global health, reform efforts are multiplying from the Lusaka Agenda to the Accra Reset, from UN80 to regional initiatives led by Africa CDC, and now MOPAN's independent assessment of mandates and effectiveness.

These are serious efforts, but there remains a lack of convergence.

Countries are not asking for more reform processes. They are asking for coherence.

That is why the 158^th Executive Board mandated WHO to convene a joint process bringing together Member States, global health initiatives and partners, civil society organizations and other stakeholders to align these efforts into a more coherent agenda.

The third lens is financing.

In 2021, Member States' dues covered just 12% of WHO's funding. The rest came from voluntary donors.

Today, voluntary contributions account for over 80% of what WHO receives much of it earmarked and donor-directed.

The result is a system with less flexibility and weaker country ownership.

The US withdrawal has intensified the pressure, but it represents much more than a financing gap.

It is a warning that the current model is losing legitimacy, sustainability and trust.

And it makes the shift toward predictable, assessed and country-driven financing more urgent than ever.

This matters because global health reform is not just about coordination. It is about power.

Who sets priorities?

Who controls financing?

Who decides what gets funded and what gets ignored?

At its core, this discussion is about rebalancing power, responsibility and trust.

Multilateralism cannot survive if countries experience it as something designed for them rather than with them.

Global institutions should focus on what only global institutions can provide: norms and standards, surveillance, emergency preparedness and equitable access to innovation.

Everything else service delivery, health system priorities and national policy choices must remain country-led, with international support aligned to national plans rather than donor preferences.

And reform cannot stop at governments and institutions.

Communities, civil society and young people must be genuine co-architects of the system, not symbolic participants within it.

The joint process now before the Health Assembly is intentionally time-bound, with a final report expected in 2027.

Its priorities are straightforward:

• align mandates;
• strengthen accountability;
• and make financing work for countries.

Because the model we need cannot be designed for yesterday's world.

Climate change, ageing populations, antimicrobial resistance, NCDs and mental health are not peripheral issues.

They define the terrain ahead.

And an architecture that continues to prioritize infectious disease while leaving these challenges structurally underfunded is not reform.

It is merely rebranding.

The gap between the system we have and the system we need has become impossible to ignore.

But that gap is also an opportunity.

Countries are not walking away from multilateralism.

They are demanding a greater role in shaping it.

And the Global South is not asking simply for a seat at a table designed elsewhere.

It is asking to help design the table itself.

That is the opportunity before us now:

to build a global health architecture that reflects the realities, priorities and responsibilities of the world we live in today.

WHO is not asking Member States to trust a process. We are asking them to lead one.